<!DOCTYPE html>
<html>
<meta charset="utf-8">
<head th:include="include :: header"></head>
<body class="gray-bg">
	<div class="wrapper wrapper-content ">
		<div class="row">
			<div class="col-sm-12">
				<div class="ibox float-e-margins">
					<div class="ibox-content">
						<form class="form-horizontal m-t" id="signupForm">
							<input th:value="${did}" id="did" name="did" class="form-control" type="hidden">
							<input th:value="${dname}" id="dname" name="dname" class="form-control" type="hidden">
							<input th:value="${wid}" id="wid" name="wid" class="form-control" type="hidden">
							<input id="applytime" th:value="${applytime}" name="applytime" class="form-control" type="hidden">
							<input id="state" th:value="${state}" name="state" class="form-control" type="hidden">

							<div class="form-group">
								<label class="col-sm-3 control-label">状态:</label>
								<div class="col-sm-8">
									<select id="request" name="request" class="form-control">
										<option value="申请出诊">申请出诊</option>
										<option value="申请停诊">申请停诊</option>
									</select>
								</div>
							</div>

							<div class="form-group">
								<label class="col-sm-3 control-label">原因:</label>
								<div class="col-sm-8">
									<input id="reason" name="reason" class="form-control" type="text">
								</div>
							</div>

							<div class="form-group">
								<div class="col-sm-8 col-sm-offset-3">
									<button type="submit" class="btn btn-primary">提交</button>
								</div>
							</div>
						</form>
					</div>
				</div>
			</div>
	</div>
	</div>
	<div th:include="include::footer"></div>
	<script type="text/javascript" src="/js/appjs/yygl/workApply/add.js">
	</script>
</body>
</html>
